Thank goodness for pediatricians. No matter what time of night, they answer the calls of frantic parents who are worried about sick children. I've made a few of those 4 a.m. calls myself to our pediatrician (an angel named Katherine), who calmly directed us to go to the hospital on one occasion, or give the baby a tepid bath on another. It's been a sort of triage that has guided us to making the right decision. And that's how of I think of the new trend in medicine called virtual visits.
Now, thanks to video conferencing applications (apps) that download to a smartphone, tablet, or home computer, people of all ages can experience a "virtual" visit with a qualified physician at any time, day or night.
Not just a fad
The benefits go beyond triage. Virtual visits are part of the shift toward making health care more convenient, and they're already popular. "We can conservatively estimate that there will be at least a million virtual doctor visits in 2016," says Dr. Ateev Mehrotra, an internist and a Harvard Medical School researcher who studies new ways of delivering health care.
Cost is another big attraction: it's $40 or $50 per visit, about half the cost of an in-person visit, and most insurance companies are now covering them. Some, such as certain Blue Cross policies, offer their own virtual doctor services free of charge. Medicare does not cover virtual visits. However, the cost of a virtual visit can be less than the out-of-pocket co-payment that Medicare requires for an in-person doctor visit.
Quality of care
Physicians who take part in virtual visits are vetted. They're assigned to you based on where you live, they are licensed in your state, they're board-certified, they carry malpractice insurance, and they can even order tests and prescriptions for you. But without seeing you in person, their ability to assess you is limited. "The physician can look at your rash, but can't examine the back of your throat or listen to your lungs. If it's a virtual visit for depression, it probably doesn't make a difference. But if you're having abdominal pain, you really need a doctor who can perform a physical examination," says Dr. Mehrotra.
Studies on virtual visits have been mixed. "People who go to a virtual visit are just as likely to have a follow-up appointment in the next few weeks, a sign that the care is equal. And the antibiotic prescribing rate is similar between virtual and in-person visits. But doctors at virtual visits are more likely to prescribe a broad-spectrum antibiotic, not one specific to your condition. And it appears that physicians are much less likely to order a test you may need, which could be a problem if you have strep throat," says Dr. Mehrotra.
How to do a virtual doctor visit
To try a virtual visit, you need a smartphone, a tablet, or a computer with a camera. If using a smartphone or tablet, download the app for the service you'd like to use. If using a computer, you can conduct visits at the website address. Two of the most widely used are Teladoc (www.teladoc.com) and Doctor On Demand (www.doctorondemand.com).
You'll have to create an account with a password, and enter your payment information, medical history, and current symptoms. You'll also need to provide important details, such as recent test results or the types and amounts of medications you're taking. A virtual doctor who doesn't have this information can make the wrong decision.
After you request a consultation, a doctor in your state will review your information, then appear in a video box on your screen within 20 minutes. If you want the doctor to see something, such as a skin rash, you'll need to hold it up to the camera. Visits last about 10 or 15 minutes. If the doctor prescribes a medication, it will be sent electronically to your pharmacy.
When to consider a virtual doctor visit
Virtual visits aren't meant to replace every trip to the doctor's office, but may be a good option for minor, temporary problems such as cold and flu, sinusitis, a sore throat, rashes, diarrhea and vomiting, or conjunctivitis ― particularly if you can't reach your doctor. Ideally, your virtual doctor should let your regular doctor know what tests were ordered and what treatments were prescribed — in any case, it's best to see your regular doctor as soon as possible. It's reassuring to know that expert advice is now just a click away. Like those on-call pediatricians, virtual doctors can guide us, no matter what time of the day or night.